Successful Control of an Outbreak by Phenotypically Identified Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit.

Content Provider	Europe PMC
Author	Priante, Elena Minotti, Chiara Contessa, Cristina Boschetto, Margherita Stano, Paola Dal Bello, Federico De Canale, Ettore Lolli, Elisabetta Baldo, Vincenzo Baraldi, Eugenio Donà, Daniele
Editor	Folgori, Laura Bresesti, Ilia Barcellini, Lucia
Copyright Year	2022
Abstract	Background: Premature newborns represent a vulnerable population, at high risk of acquiring nosocomial infections during neonatal intensive care unit (NICU) admission. Multidrug-resistant organisms represent the greatest concern due to their intrinsic virulence and the limited therapeutic options. Resistant Enterobacterales are a growing threat for critically ill neonates, with increasing numbers of NICU outbreaks caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales being described. This study reports the early detection and successful control of an outbreak caused by ESBL-producing Klebsiella pneumoniae (ESBL-KP) in an Italian NICU in February 2021. Results: A total of 13 newborns tested positive for ESBL-KP between 2–9 February 2021, of whom four (31%) had a bloodstream infection. Two were critically ill, extremely premature newborns who died because of multiple comorbidities, and two were cured after treatment with meropenem. All other patients survived and were either discharged home or moved to other hospitals/wards in good clinical condition. ESBL-KP ST45 was found in all isolates by multilocus sequence typing (MLST) analysis. An outbreak control plan was set, including surveillance cultures for all neonates, NICU environments, and medical devices, along with the extended use of contact precautions and cohorting. In addition, the infection control plan was carried out through reinforcement and enhancement measures to guarantee maximal compliance. The outbreak was successfully controlled in seven days, given that no further cases were identified after 9 February. The source of the ESBL-KP outbreak was not identified through environmental sampling. Conclusions: Thanks to multidisciplinary management, a threatening outbreak of ESBL-KP in a NICU was controlled in few days. The prompt recognition of the event onset and the adoption of infection control interventions helped contain the bacteria spread on the ward.
Journal	Antibiotics (Basel, Switzerland)
Volume Number	11
PubMed Central reference number	PMC9686647
Issue Number	11
PubMed reference number	36421293
e-ISSN	20796382
DOI	10.3390/antibiotics11111649
Language	English
Publisher	MDPI
Publisher Date	2022-11-18
Access Restriction	Open
Rights License	Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). © 2022 by the authors.
Subject Keyword	outbreak newborn extended-spectrum beta-lactamase-producing Klebsiella pneumoniae neonatal intensive care unit multidrug-resistant organism
Content Type	Text
Resource Type	Article
Subject	Biochemistry Pharmacology, Toxicology and Pharmaceutics Microbiology Pharmacology (medical) Infectious Diseases Microbiology (medical)